Southern medical journal
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Southern medical journal · Apr 1989
Case ReportsAcute upper airway obstruction in rheumatoid arthritis of the cricoarytenoid joints.
We have reported two cases of acute, life-threatening upper airway obstruction due to previously unrecognized rheumatoid arthritis of the cricoarytenoid joints with severe acute and chronic deformities of the larynx. Attempted endotracheal intubation with the rigid laryngoscope failed in each case, resulting in the need for emergency tracheostomy. We recommend the use of the fiberoptic bronchoscope for elective or emergency endotracheal intubations in patients with severe rheumatoid arthritis involving the cervical spine and the larynx.
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Southern medical journal · Mar 1989
Comparative StudyPreoperative cardiac consultations in a teaching hospital.
Perioperative consultations may play a major role in the care of surgical patients in an era of prospective payments. Since insurance reimbursement policy favors limitations in the number of consultants on a case, general medicine ("holistic") consultation services may become preferred perioperative consultants in the future. To focus curriculum planning for perioperative consultants, we reviewed the content of 60 consecutive perioperative consultations by noncardiac surgery services to a university cardiology consultation team. ⋯ The most frequent cardiac conditions for evaluation were congestive heart failure, old myocardial infarctions, murmurs, abnormal electrocardiograms, angina, and previous histories of coronary artery bypass surgery. Few patients needed management of arrhythmias. Physicians involved in perioperative care should assess their abilities in managing these cardiac conditions.
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Southern medical journal · Mar 1989
Comparative StudyHypertension: variations in prevalence in the black population.
Prevalence trends in hypertension in black men and women show an inversion at about ages 45 to 54 years. Incidence, mortality, and treatment of hypertension after age 35 can probably be related to this inversion. ⋯ Mortality data partially explain the inversion. Long-term epidemiologic studies of hypertension in black elderly persons are needed to explain these variations in prevalence, which may have a beneficial impact on treatment and prognosis.
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Southern medical journal · Jan 1989
Review Case ReportsSubdural injection of local anesthetics and morphine: a complication of attempted epidural anesthesia.
We have reported a case of unintentional, roentgenographically proven cannulation of the lumbar subdural space. Injection of 13 ml of local anesthetic provided satisfactory anesthesia for cesarean section, and administration of 1 mg of morphine resulted in postcesarean analgesia for 22 hours. Subdural catheterization is a possible explanation for the occasionally irregular course of an apparent "epidural" anesthetic.
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To understand fully a physician's role in society, and to deal successfully with the current sense of crisis, the medical profession must evolve a world-view that appropriately relates a physician to the patient, to the practice environment, to the base of knowledge, and to the physician's own sense of self. Such a world-view would be multilevel and interdisciplinary, and would be based on interactions and adaptations of physicians to life systems. Medicine's world-view must provide a philosophic milieu intérieur that leads to a proper equilibrium between medicine's technologic skills and its humanistic concerns.